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Providing culturally competent primary care for immigrant and refugee women. A Cambodian case study.

Currently, one of every 13 U.S. residents is foreign born. A 1991 survey of certified nurse-midwives (CNMs) indicated that 51% of the respondents serve immigrant women. Using a case study approach, this article illustrates barriers to health care experienced by foreign-born women and demonstrates how cultural competence increases provider effectiveness in meeting the unique needs of this population. Effective primary care requires understanding the context of the refugee experience and its physical and emotional sequelae; addressing geographic, linguistic, economic, and cultural barriers; and providing high-quality care through the efficient use of resources without unduly controlling women's choices. Providing care within the context of the traditional family structure, gender roles, family support systems, and community services and resources further enhances health care services. Equally important is the establishment of a sustained partnership with clients, based on the support of protective traditional health practices and the recognition that a woman is expert in her own health. By respecting the complex cultural, political, economic, and personal backgrounds that contribute to immigrant women's perceptions of health, illness, and health care needs, culturally competent primary care providers serve diverse populations more effectively and help to enrich the communities in which they live and work.

Adult↗
PubMed2002

Screening of international immigrants, refugees, and adoptees.

Frequently clinicians are faced with screening and providing preventive care to immigrants, refugees, and international adoptees. Evidence-based medicine on which to base screening protocols for these populations is lacking. It is important to review all health and vaccination records of the patient. In addition to acute symptoms, one should inquire about the symptoms of diseases prevalent in the country of origin or transit (e.g., hematuria). Many unexpected pathologic conditions may be detected by a thorough physical examination. If a reliable immunization record is presented, one need not repeat the vaccines or check titers. Remaining vaccines should be administered according to ACIP guidelines, except for certain populations (e.g., adoptees). Routine laboratory screening tests should include CBC with differential, stool for ova and parasites, urinalysis, general chemistry profile, serology for hepatitis B, and tests for HIV and syphilis. A tuberculin skin test should be performed on all immigrants, and a chest radiograph should be obtained for any patient with symptoms or a positive PPD. Lead level, hepatitis C, and TSH should be obtained for all children and most adoptees. In addition, special screening tests (e.g., for malaria, hepatitis C, and STIs) may be indicated in high-risk populations. A more organized screening system that emphasizes evidence-based and population-specific screening protocols and better communication between international, federal, state, and local levels is needed in the United States.

Adoption↗
PubMed2000

Infant and child mortality rates among Palestinian refugee populations.

We estimated infant and early child mortality rates among Palestinian refugees using maternal and child services in Jordan, Gaza, Lebanon, and Syria. Early childhood mortality per 1000 live births was 35 in Jordan, 36 in Gaza, 37 in Lebanon, and 32 in Syria. Infant mortality rates were 32 in Jordan, 33 in Gaza, 35 in Lebanon, and 29 in Syria.

Arabs↗
PubMed1981

Resistance of Plasmodium falciparum malaria to sulfadoxine-pyrimethamine ('Fansidar') in a refugee camp in Thailand.

Since it was first introduced 'Fansidar' (pyrimethamine 25 mg, sulfadoxine 500 mg) has been the preferred treatment for uncomplicated chloroquine-resistant Plasmodium falciparum malaria in Thailand. Because many patients at a refugee camp in Thailand did not seem to be responding to therapy 9 patients who received fansidar for P. falciparum infection were followed up with serial parasite counts. In all of them the infection was resistant to fansidar. The results of this study suggest that fansidar resistance is prevalent at this camp and should prompt more exhaustive studies of the epidemiology of fansidar resistance in the area.

Adolescent↗
PubMed1997

Refugee children in Sweden: post-traumatic stress disorder in Iranian preschool children exposed to organized violence.

Fifty preschool children from 47 Iranian families living as refugees in Sweden were assessed individually, simultaneously with parental interviews focusing on exposure to organized violence and post-traumatic stress symptomatology in the children. Information given by the children increased the prevalence of a Post-Traumatic Stress Disorder (PTSD) diagnosis (DSM-III-R) from 2% to 21% in the 42 children with traumatic exposure through war and political persecution. The amount of traumatic exposure was strongly related to the prevalence of PTSD. The stability of prevalence was high in a follow-up 2 and 1/2 years later; 23% of the children with traumatic exposure still met the full criteria of PTSD according to DSM-III-R.

Child↗
PubMed2001

Hepatitis A control in a refugee camp by active immunization.

An outbreak of hepatitis A occurred among children of a refugee camp in Croatia. In order to disrupt the outbreak, we decided to vaccinate children from 1 to 15 years of age in the camp, in addition to intensified general preventive measures. Assuming high prevalence of hepatitis A virus antibodies within this population, we conducted anti-HAV testing of the children eligible for vaccination. Of 108 children tested, 74 (68.5%) were anti-HAV positive. We vaccinated 34 children. One month after vaccination 31 previously negative children were tested for anti-HAV and 30 of them were found positive, suggesting a seroconversion rate of 96.8%. One child fell ill 5 days after vaccination, after whom no new cases of hepatitis A occurred. Thus we conclude that active immunization is a successful means of stopping an outbreak of hepatitis A.

Adolescent↗
PubMed2003

War, gender and culture: Mozambican women refugees.

Analyses of the psychological sequelae of war-related violence for women tend to rely on the concepts developed in research on male combatants. Post-traumatic stress disorder or varying combinations of its symptoms are identified as the principal outcomes of war-related events for women. By and large, the dominant literature does not examine possible outcomes which could be specified by gender. This paper refers to the war in Mozambique during the 1970s and 1980s as a typical illustration of how women are an integral part of the battlefield. It draws on research on African women and uses testimony of Mozambican women refugees who settled in South Africa to explore how gender is linked to psycho-social outcomes of massive social conflict. The paper argues that a richer understanding of the psycho-social outcomes of war and the needs of survivors is promoted by investigating gender in specific historical situations and how this frames the responses people have to experiences of violence and social destruction.

Adaptation, Psychological↗
PubMed1997

The influence of culture and context on the pre- and post-migration experience of school-aged refugees from Central America and Southeast Asia in Canada.

Pre- and post-migration contexts of refugee children from Central America and Southeast Asia were compared. The results suggest that the culture of origin radically modulates the relationship between the pre-migration experience and the developing post-migration universe. In the case of the Central American children, the state-sponsored violence suffered in the country of origin is strongly associated with subsequent family conflicts, whereas in the case of the Southeast Asians, conflict is associated with an active social network in the community of origin, suggesting that there is a delicate balance between the support provided and the burden imposed by the extended family.

Anxiety, Separation↗
PubMed2003

Interactive group education for refugees from the Former Yugoslavia to reduce their oil consumption.

In 1999 at an outpatient dietetic consultation in Geneva, Switzerland, 20% of the patients were refugees. Most were from the Former Yugoslavia. The main goal of dietary counseling was to decrease their fat consumption. As one-on-one counseling was unsuccessful, a pilot intervention was developed to explore the potential of participatory workshops for identifying and implementing appropriate behaviors. Four series of three workshops were held. Participants identified and practiced ways to reduce fat consumption. Knowledge skills were measured on completion of the workshops and 6 months later. Oil was highly valued in participants' representation of health. However, average reduction of oil per recipe was 58%, or 35 ml (95% CI: 15-55). The application of oil-sparing techniques increased nine-fold. Such an approach may be an alternative to one-on-one dietary counseling where this is ineffective. Next steps should include a trial to determine the impact of new skills on actual fat consumption.

Ambulatory Care↗
PubMed2001

Trauma experience of North Korean refugees in China.

OBJECTIVES: We examined trauma experience and mental health conditions among North Korean migrants in China. METHODS: Personal interviews of 170 North Korean "food refugees" in China were conducted in 1999. Structured questionnaires were used to identify specific trauma experience and symptoms of post-traumatic stress, anxiety, and depression. RESULTS: All participants surveyed reported trauma exposure, with food and water shortage (93%) and illness without access to medical care (89%) being the most frequently cited events. Post-traumatic stress disorder was suspected in 56% of the respondents. Above-threshold scores on anxiety and depression were found in 90% and 81% of the cases, respectively. CONCLUSIONS: The burden on the part of North Korean migrants in China who experience trauma appears to be very high. An international call for action is warranted to monitor and safeguard the mental health status of this vulnerable segment of people and respond to their urgent psychiatric and medical care needs.

Adult↗
PubMed2004

Prevalence of Pediculus capitis infestation among school children of Chinese refugees residing in mountanous areas of northern Thailand.

An epidemiologic survey of Pediculus capitis infestation among Akka aboriginal and Han children of Chinese refugees living in mountainous areas at elevations of 1,100 to 1,400 m in Chiang-Rai Province of northern Thailand was conducted during January 2003. Of the 303 children examined, 43 (14.2%) had P. capitis infestation. The overall infestation rate for P. capitis in Akka children (29.3%, 12/41) was significantly higher than that in Han children (11.8%, 31/262; chi2 = 8.161, p = 0.002). The prevalence in Akka (52.2%, 12/23) and Han girls (19.7%, 31/157) was higher than that in Akka (0%) and Han boys (0%), respectively (p < 0.001), and the prevalence was higher in Akka girls than in Han girls (chi2 = 10.978, p = 0.001). The high prevalence of P. capitis infestation among these girls was possibly due to poor environmental hygiene and unavailability of sufficient water.

Adolescent↗
PubMed2002

Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7-20 years after resettlement in Australia.

During the period 1974-91 large numbers of Southeast Asian immigrants and refugees were resettled in Western countries, including Australia. Health screening during this period demonstrated that intestinal parasite infections were common. A cross-sectional survey of 95 Laotian settlers who arrived in Australia on average 12 years prior to the study was conducted to determine if chronic intestinal parasite infections were prevalent in this group. Twenty-three participants had positive Strongyloides stercoralis test results (22 with positive serology, including I with S. stercoralis larvae detected in faeces and another with larvae and equivocal serology). Of these 23 participants, 18 (78%) had an elevated eosinophil count. Two patients had eggs of Opisthorchis spp. identified by faecal microscopy. The detection of chronic strongyloidiasis in Laotian settlers is a concern because of the potential serious morbidity associated with this pathogen.

Adolescent↗
PubMed2000

HBV, HCV and HDV infections in Albanian refugees in Southern Italy (Apulia region).

The seroprevalence of hepatitis B, C and D markers was assessed in a sample of 670 Albanian refugees in Southern Italy in 1997. The mean age was 25 years (S.D. = 12.3). Of study subjects 62.1% (95% CI: 58.4-65.7) were positive for anti-HBc antibodies and 13.6% (95% CI: 10.9-16.1) for HBsAg. The prevalence of anti-HBs was 47.6% (95% CI: 43.8-51.3). Among HBsAg carriers the prevalence of HBeAg was 7.7% (95% CI: 2.2-13.1). The highest carrier rate for HBsAg (25.5%; 95% CI: 16.7-34.3) was found in the age group 21-25 years. A relevant finding was a prevalence of HBsAg of 8.1% in children 10 years and under. The prevalence of anti-HCV antibodies was 0.3% (95% CI: 0.0-0.7) while only one of the HBsAg carriers was positive for anti-HDV (1.1%, 95% CI: 0-3.2). In Albania, hepatitis B infection represents a public health priority that should be addressed by a universal vaccination campaign.

Adolescent↗
PubMed1998

Between myth and madness: the premigration dream of leaving among young Somali refugees.

Many young Somali refugees experience long premigration waits and a poorly delimited transition period in a succession of countries before reaching their final destination. During this difficult passage, a myth dealing with departure and exodus is collectively constructed, and it serves as a dynamic, mobilizing dream that orients individual strategies. This substitution of "dream travel" for real travel during the transition period, especially if it is prolonged, may cause Somali youths to lose contact with reality and eventually to slide into madness. The authors' approach is based on three assumptions: (a) that pastoralism predisposes the Somali to value travel as a way of maturing, (b) that age-based peer groups create special migratory dynamics, and (c) that an ethic of solidarity involves many people in the adventure of a migrant youth. When trapped in an indefinite transition period, young men share khat-chewing sessions during which they relate success stories and dreams of leaving. Many grow frustrated with the delay, and if their departure plans fall through, the "dream trip" often becomes "dream madness." Actual cases illustrate how some young Somali get lost in their dreams. A young Somali's vulnerability is heightened when he extricates himself from the system of reciprocal obligations or when the liminal stage ends with the mourning of the impossible dream. In the universe of madness visited by some young Somali migrants, the boundaries between the real and the imaginary are poorly marked. The paper is based on fieldwork carried out in the Horn of Africa and in Canada, interviews with Somali immigrants and members of the community, and clinical psychiatric data collected in Montreal.

Adaptation, Psychological↗
PubMed2001

A unique panic-disorder presentation among Khmer refugees: the sore-neck syndrome.

This article describes a previously unreported cultural syndrome among Khmer refugees. This common presentation of distress centers on the complaint of a sore neck, the sufferer fearing that wind-and-blood pressure may burst the vessels in this area. During an acute episode, a Khmer endures many--if not all--of the following neck-and-head complaints: headache, blurry vision, a buzzing in the ear, and dizziness. While in the throes of the sore-neck attack, the patient frequently experiences palpitations as well as other symptoms of autonomic arousal, such as diaphoresis, shortness of breath, and trembling. A sufferer of sore-neck episodes often meets panic disorder criteria. In a clinic survey, thirty-five out of eighty-five patients (41%) were found to currently suffer the "sore-neck syndrome" (i.e., to have endured at least one episode in the last month), with almost all of these thirty-five patients (80%) fearing death during the acute event. The sore-neck syndrome represents a common and important way in which distress becomes embodied. The clinician must learn this body language; otherwise, the patient's communication of psychic, interpersonal, and physical pain goes unheard--and grave somatic suffering and disability unattended to--discounted as puzzling somatic complaints and unreasonable obsessionalism about blood pressure.

Adult↗
PubMed1999

Comparing perceived self-efficacy among adolescent Bosnian and Croatian refugees with and without posttraumatic stress disorder.

To examine the relationship between posttraumatic stress disorder (PTSD) and perceived self-efficacy (PSE), 98 Bosnian and Croatian refugees, ages 13-18, completed Bandura's Children's Multidimensional Scales of Perceived Self-Efficacy, which measure self-predicted social functioning in 9 areas. Through interviews, participants were categorized according to DSM-IV criteria as traumatized PTSD-positive, traumatized PTSD-negative, and nontraumatized. ANCOVAs showed PTSD-positive participants exhibit higher PSE than nontraumatized participants in 5 of 9 areas. No significant differences among 3 female groups were observed; however, nontraumatized boys demonstrated lower PSE than the 2 traumatized groups in 7 of 9 areas. Thus, PTSD did not have a negative impact on PSE in this cultural context. Furthermore, surviving traumatic experience and preserving social support networks may be protective factors for maintaining high levels of PSE.

Adolescent↗
PubMed2004

Quality of life among Iranian refugees resettled in Sweden.

The relationships between quality of life, psychopathological manifestations and coping related variables (coping resources, social support, sense of coherence) were examined among individuals who have perceived several severe traumata. One hundred Iranian refugees resettled in Sweden have been investigated by the Symptom Checklist (SCL-90-R), the Beck Depression Inventory (BDI), the Coping Resources Inventory (CRI), and the Interview Schedule for Social Interaction (ISSI), the Sense of Coherence Scale (SOC), and the WHOQoL-100 questionnaire in a cross-sectional study. Individuals, traumatized by combat experiences as a soldier during the war, with low BDI scores showed on average the significantly highest overall quality of life, the best physical health, the highest scores according to the sense of coherence most pronounced for "Meaningfulness," and the best availability of social integration compared to participants who did not had these experiences in combats and those with the experience but scored high in the BDI. Quality of life, coping resources, and social support were found closely related to psychopathological manifestations. Motivational orientations (highly developed Meaningfulness-SOC) and various coping competencies probably enable some traumatized individuals to resist against several traumata and to live in a good quality of life without psychopathological disturbances.

Acculturation↗
PubMed2004

CBT for Vietnamese refugees with treatment-resistant PTSD and panic attacks: a pilot study.

We examined the feasibility, acceptability, and therapeutic efficacy of a culturally adapted cognitive-behavior therapy (CBT) for twelve Vietnamese refugees with treatment-resistant posttraumatic stress disorder (PTSD) and panic attacks. These patients were treated in two separate cohorts of six with staggered onset of treatment. Repeated measures Group x Time ANOVAs and between-group comparisons indicated significant improvements, with large effect sizes (Cohen's d) for all outcome measures: Harvard Trauma Questionnaire (HTQ; d = 2.5); Anxiety Sensitivity Index (ASI: d = 4.3); Hopkins Symptom Checklist-25 (HSCL-25), anxiety subscale (d = 2.2); and Hopkins Symptom Checklist-25, depression subscale (d = 2.0) scores. Likewise, the severity of (culturally related) headache-and orthostasis-cued panic attacks improved significantly across treatment

Adult↗